Question 5: What are the recommended practices for avoiding unintended consequences of EHR implementation?

As we've emphasized, implementing an EHR is a difficult process that may disrupt your organization's work and upset some colleagues and patients. The following is a list of implementation practices based on expert consensus that should help you avoid EHR-related unintended consequences during EHR implementation

  • Project scope is defined, with clear, reasonable, measurable goals.
  • Users are well informed and engaged in the implementation.
  • Initial milestones should produce early "wins" that will help maintain momentum toward more difficult long-term objectives.
  • Plans are detailed but not overly complicated.
  • Multiple mechanisms for collecting feedback from users are in place.
  • The capacity to analyze and act on user feedback is in place.
  • Leaders should work to develop consensus when disagreements arise.
  • Use of consultants should be carefully planned with specific objectives before they are employed.
  • A critical mass of users must be ready for the implementation.
  • A plan for involving clinicians must be developed, followed, and evolved.
  • Metrics for success should be determined beforehand and evaluated over time.
  • The organization should hire and deploy staff where and when they are most needed.
  • Maintenance routines and an environment to support ongoing quality improvement should be established

Source: Ash JS, Stavri Z, Kuperman GJ, et al. Consensus Statement on Considerations for a Successful CPOE Implementation. J Am Med Inform Assoc. 2003; 10: 229-234.

Health IT Journeys: ONC has collected a number of success stories from early adopters of EHRs.

Managing Expectations About How EHR Implementation Will Affect Workflow: Clinicians at a college student health center complained that the introduction of an EHR significantly increased their workload. In particular, physicians and nurse practitioners complained that the additional time they had to spend learning to use the new system combined with the additional burden of documenting patient visits in the EHR reduced their capacity to focus on delivering patient care.